Provider Demographics
NPI:1912195462
Name:FAIRCHILD, CARL COLLIN (PHARMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:COLLIN
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:PHARMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 E GERMANN RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1410
Mailing Address - Country:US
Mailing Address - Phone:480-280-0669
Mailing Address - Fax:480-821-5111
Practice Address - Street 1:3569 ZAFARANO DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2618
Practice Address - Country:US
Practice Address - Phone:480-280-0669
Practice Address - Fax:480-821-5111
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD34761223G0001X
AZD74621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice